An abdominal aortic aneurysm is when the large blood vessel that supplies blood to the abdomen, pelvis, and legs becomes abnormally large or balloons outward.

Causes, incidence, and risk factors

The exact cause is unknown, but risk factors for developing an aortic aneurysm include:

Smoking

High blood pressure

High cholesterol

Male gender

Emphysema

Genetic factors

Obesity

An abdominal aortic aneurysm can develop in anyone, but is most often seen in males over 60 who have one or more risk factors. The larger the aneurysm, the more likely it is to rupture and break open.

Symptoms

Aneurysms develop slowly over many years and often have no symptoms. If an aneurysm expands rapidly, tears open (ruptured aneurysm), or blood leaks along the wall of the vessel (aortic dissection), symptoms may develop suddenly.

The symptoms of rupture include:

Pain in the abdomen or back -- severe, sudden, persistent, or constant. The pain may radiate to the groin, buttocks, or legs.

Clammy skin

Nausea and vomiting

Rapid heart rate

Shock

Signs and tests

Your doctor will examine your abdomen. The exam also will include an evaluation of pulses and feeling in your legs. The doctor may find:

A lump (mass) in the abdomen

Pulsating sensation in the abdomen

Stiff or rigid abdomen

You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. Your doctor may find this problem by doing the following tests:

CT scan of the abdomen

Ultrasound of the abdomen

Either of these tests may be done when you're having symptoms.

Treatment

If you have bleeding inside your body from an aortic aneurysm, you will have open abdominal aortic aneurysm repair.

If the aneurysm is small and there are no symptoms:

You and your doctor must decide whether the risk of having surgery is smaller than the risk of bleeding if you do not have surgery.

Your doctor may recommend checking the size of the aneurysm with ultrasound tests every 6 months, to see if the aneurysm is getting bigger.

Surgery is usually recommended for patients who have aneurysms bigger than 2 inches (5.5 cm) across and aneurysms that are growing quickly. The goal is to perform surgery before complications or symptoms develop.

There are two approaches to surgery:

In a traditional (open) repair, a large cut is made in your abdomen. The abnormal vessel is replaced with a graft made of man-made material, such as Dacron.

The other approach is called endovascular stent grafting. This procedure can be done without making a large cut in your abdomen, so you may get well faster. If you have certain other medical problems, this may be a safer approach. Endovascular repair is rarely done for a leaking or bleeding aneurysm.

Expectations (prognosis)

The outcome is usually good if an experienced surgeon repairs the aneurysm before it ruptures. However, less than 80% of patients survive a ruptured abdominal aneurysm.

Complications

When an abdominal aortic aneurysm ruptures, it is a true medical emergency. Aortic dissection occurs when the innermost lining of the artery tears and blood leaks into the wall of the artery. This most commonly occurs in the aorta within the chest.

Complications include:

Arterial embolism

Heart attack

Hypovolemic shock

Kidney failure

Stroke

Calling your health care provider

Go to the emergency room or call 911 if you have pain in your belly or back that does not go away or is very bad.

Prevention

To reduce the risk of developing aneurysms:

Eat a heart-healthy diet, exercise, stop smoking (if you smoke), and reduce stress to help lower your chances of having a blocked artery again.

Your health care provider may give you medicine to help lower your cholesterol.

If you were given medicines for blood pressure or diabetes, take them as your doctor has asked you to.

People over age 65 who have smoked at any time in their life should have a screening ultrasound performed once.

Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.

See also: Abdominal pain-children under 12

Considerations

Almost everyone has pain in the abdomen at one time or another. Most of the time, it is not caused by a serious medical problem.

How bad your pain is does not always reflect the seriousness of the condition causing the pain.

For example, you might feel severe abdominal pain if you have gas or stomach cramps due to a viral gastroenteritis.

Sometimes, life-threatening conditions such as colon cancer or early appendicitis may only cause mild pain or no pain.

Other ways of describing pain in your abdomen include:

Pain may be generalized, meaning that you feel it in more than half of your belly. This is more typical for a stomach virus, indigestion, or gas. If the pain becomes more severe, it may be caused by a blockage of the intestines.

Pain that is localized is found in only one area of your belly. This type of pain is more likely to be a sign of a problem in an organ, such as the appendix, gallbladder, or stomach.

Cramp-like pain is usually not serious, and is more likely to be due to gas and bloating. It is often followed by diarrhea. More worrisome signs include pain that occurs more often, lasts than 24 hours, or occurs with a fever.

Colicky pain is pain that comes in waves. It usually starts and ends suddenly, and is often severe. Kidney stones and gallstones are common causes of this type of belly pain.

Common Causes

Many different conditions can cause abdominal pain. The key is to know when you need to get immediate medical care. Some times you may only need to call a doctor if your symptoms continue.

Less serious causes of abdominal pain include:

Constipation

Irritable bowel syndrome

Food allergies or intolerance (such as lactose intolerance)

Food poisoning

Stomach flu

Other possible causes include:

Appendicitis

Abdominal aortic aneurysm

Bowel blockage or obstruction

Cancer of the stomach, colon, and other organs

Cholecystitis (inflammation of the gallbladder) with or without gallstones

Decreased blood supply to the intestines (ischemic bowel)

Diverticulitis

Heartburn, indigestion, or gastroesophageal reflux (GERD)

Inflammatory bowel disease (Crohn's disease or ulcerative colitis)

Kidney stones

Pancreatitis (swelling or infection of the pancreas)

Ulcers

Sometimes, abdominal pain may be due from a problem somewhere else in your body, such as your chest or pelvic area. For example, you may have abdominal pain if you have:

Heart attack

Severe menstrual cramps

Endometriosis

Muscle strain

Pelvic inflammatory disease (PID)

Pneumonia

Tubal (ectopic) pregnancy

Urinary tract infections

Home Care

If you have mild abdominal pain, the following tips might be helpful:

Sip water or other clear fluids.

Avoid solid food for the first few hours.

If you have been vomiting, wait 6 hours, and then eat small amounts of mild foods such as rice, applesauce, or crackers. Avoid dairy products.

If the pain is high up in your abdomen and occurs after meals, antacids may help, especially if you feel heartburn or indigestion. Avoid citrus, high-fat foods, fried or greasy foods, tomato products, caffeine, alcohol, and carbonated beverages.

Avoid aspirin, ibuprofen or other anti-inflammatory medications, and narcotic pain medications unless your health care provider prescribes them. If you know that your pain is not related to your liver, you can try acetaminophen (Tylenol).

Call your health care provider if

Seek immediate medical help or call your local emergency number (such as 911) if you:

Are currently being treated for cancer

Are unable to pass stool, especially if you are also vomiting

Are vomiting blood or have blood in your stool (especially if maroon or dark, tarry black)

Have chest, neck, or shoulder pain

Have sudden, sharp abdominal pain

Have pain in, or between, your shoulder blades with nausea

Have tenderness in your belly, or your belly is rigid and hard to the touch

Are pregnant or could be pregnant

Had a recent injury to your abdomen

Have difficulty breathing

Call your doctor if you have:

Abdominal discomfort that lasts 1 week or longer

Abdominal pain that does not improve in 24 - 48 hours, or becomes more severe and frequent and occurs with nausea and vomiting

Bloating that persists for more than 2 days

Burning sensation when you urinate or frequent urination

Diarrhea for more than 5 days

Fever (over 100°F for adults or 100.4°F for children) with your pain

Prolonged poor appetite

Prolonged vaginal bleeding

Unexplained weight loss

What to expect at your health care provider's office

Your health care provider will perform a physical exam and ask questions about your symptoms and medical history. Your specific symptoms, the location of pain and when it occurs will help your health care provider diagnosis the cause.

You may be asked the following questions:

Where do you feel the pain?

Is the pain all over or in a specific location?

Does the pain move into your back, groin, or down your legs?

Is the pain severe, sharp, or cramping?

Do you have it all the time or does it come and go?

Does the pain wake you up at night?

Have you had similar pain in the past? How long has each episode lasted?

When does the pain occur? For example, after meals or during menstruation?

What makes the pain worse? For example, eating, stress, or lying down?

What makes the pain better? For example, drinking milk, having a bowel movement, or taking an antacid?

What medications are you taking?

Have you had a recent injury?

Are you pregnant?

What other symptoms do you have?

Tests that may be done include:

Barium enema

Blood, urine, and stool tests

CT scan

Colonoscopy or sigmoidoscopy

EKG (electrocardiogram) or heart tracing

Ultrasound of the abdomen

Upper GI and small bowel series

X-rays of the abdomen

Prevention

The following steps may help prevent some types of abdominal pain:

Avoid fatty or greasy foods.

Drink plenty of water each day.

Eat small meals more frequently.

Exercise regularly.

Limit foods that produce gas.

Make sure that your meals are well-balanced and high in fiber. Eat plenty of fruits and vegetables.

Abdominal rigidity is stiffness of the muscles in the belly area, which can be felt when touched or pressed.

Considerations

When there is a sore area inside the belly or abdomen, the pain will get worse when a hand presses against muscles of the abdomen.

Your fear or nervousness about being touched (palpated) may cause this symptom, but there should be no pain.

If you have pain when you are touched and you tighten the muscles to "guard" against more pain, it is more likely caused by a physical condition inside your body. The condition may affect one or both sides of your body.

Abdominal rigidity may occur along with:

Abdominal tenderness

Nausea

Pain

Swelling

Vomiting

Common Causes

Abscess inside the abdomen

Appendicitis

Cholecystitis caused by gallstones

Hole that develops through the entire wall of the stomach, small intestine, large bowel, or gallbladder (gastrointestinal perforation)

Injury to the abdomen

Peritonitis

Home Care

Call your health care provider if

All forms of involuntary rigidity and rebound tenderness (pain when the abdomen is gently pressed and then the pressure is released) need immediate medical attention, preferably in an emergency room. You may need surgery.

What to expect at your health care provider's office

You will probably be seen in an emergency room instead of at your doctor's office.

The health care providerwill perform a physical examination. The physical examination may include a pelvic (and possibly a rectal) examination.

The health care provider will ask questions about your symptoms, such as:

When did they first start?

What other symptoms do you have at the same time? For example, do you have abdominal pain?

Diagnostic tests that may be performed include:

Barium studies of the stomach and intestines (such as an upper GI series)

Blood tests

Colonoscopy

Gastroscopy

Peritoneal lavage

Stool studies

Urine tests

X-ray of the abdomen

X-ray of the chest

You will probably not be given any pain relievers until a diagnosis is made. Pain relievers can hide your symptoms.

Considerations

Abdominal sounds (bowel sounds) are made by the movement of the intestines as they push food through. Since the intestines are hollow, bowel sounds can echo through the abdomen much like the sounds heard from water pipes.

Most bowel sounds are harmless and simply mean that the gastrointestinal tract is working. A doctor can check abdominal sounds by listening to the abdomen with a stethoscope (auscultation).

Although most bowel sounds are normal, there are some instances in which abnormal bowel sounds provide valuable information about the health of the body.

Ileus is a condition in which there is a lack of intestinal activity. Many medical conditions may lead to ileus. It is important to evaluate it further because gas, fluids, and the contents of the intestines can build up and break open (rupture) the bowel wall. The doctor may be unable to hear any bowel sounds when listening to the abdomen.

Reduced (hypoactive) bowel sounds include a reduction in the loudness, tone, or regularity of the sounds. They are a sign that intestinal activity has slowed.

Hypoactive bowel sounds are normal during sleep, and also occur normally for a short time after the use of certain medications and after abdominal surgery. Decreased or absent bowel sounds often indicate constipation.

Increased (hyperactive) bowel sounds can sometimes be heard even without a stethoscope. Hyperactive bowel sounds mean there is an increase in intestinal activity. This can sometimes occur with diarrhea and after eating.

Abdominal sounds are always evaluated together with symptoms such as:

Gas

Nausea

Presence or absence of bowel movements

Vomiting

If bowel sounds are hypoactive or hyperactive and there are other abnormal symptoms, it is important for you to have continued follow-up with your health care provider.

For example, no bowel sounds after a period of hyperactive bowel sounds can mean there is a rupture of the intestines, or strangulation of the bowel and death (necrosis) of the bowel tissue.

Very high-pitched bowel sounds may be a sign of early bowel obstruction.

Common Causes

Most of the sounds you hear in your stomach and intestines are due to normal digestion and are no need for concern. Many conditions can cause hyperactive or hypoactive bowel sounds. Most are harmless and do not need to be treated.

The following is a list of more serious conditions that can cause abnormal bowel sounds.

Mechanical bowel obstruction is caused by hernia, tumor, adhesions, or similar conditions that can block the intestines.

Paralytic ileus is a problem with the nerves to the intestines. Reduced nerve activity can result from:

Blood vessel blockage

Bowel blockage

Chemical imbalances such as hypokalemia

Infection

Overexpansion of the bowel

Trauma

Other causes of hypoactive bowel sounds:

Drugs that reduce intestinal movements such as opiates (including codeine), anticholinergics, and phenothiazines

General anesthesia

Radiation to the abdomen

Spinal anesthesia

Surgery in the abdomen

Other causes of hyperactive bowel sounds:

Crohn's disease

Diarrhea

Food allergy

GI bleeding

Infectious enteritis

Ulcerative colitis

Call your health care provider if

Call your health care provider if you experience any symptoms such as:

Bleeding from your rectum

Nausea

Prolonged diarrhea or constipation

Vomiting

What to expect at your health care provider's office

The doctor will perform a physical exam and ask you questions about your medical history. You may be asked:

What other symptoms do you have?

Have you noticed any abdominal pain?

Have you noticed any diarrhea?

Have you noticed any constipation?

Have you noticed any abdominal distention?

Have you noticed any excessive or absent gas (flatus)?

Have you noticed any bleeding from the rectum or black stools?

Depending on the findings of your physical exam, the doctor may order more tests. Tests may include:

Abdominal CT scan

Abdominal x-ray

Blood tests

Endoscopy

If there are signs of an emergency, you will be sent to the hospital. A tube will be placed through your nose or mouth into the stomach or intestines. This empties the contents of your intestines. Usually, you will not be allowed to eat or drink anything so your intestines can rest. You will be given fluids through a vein (intravenously).

You may be given medication to reduce symptoms and to treat the cause of the problem. (The specific medication depends on the situation.) Some people may need surgery right away.

Abnormal posturing is different from "bad posture" or "slouching." Instead, it involves holding a body position, or moving one or more parts of the body in a certain way.

Abnormal posturing may be a sign of certain injuries to the brain or spinal cord.

Considerations

Abnormal posturing that occurs with little stimulation is a sign of serious central nervous system damage. Problems with or damage to the nervous system may appear as posturing when a person does certain tasks, such as walking on the sides of the feet, toes, or heels.

Normally when a muscle contracts, the muscles on the opposite side of the joint offer resistance to the contraction. Abnormal posturing occurs when damage to the central nervous system (brain or spinal cord) reduces or prevents opposition to muscle contraction in certain muscle groups.

See the following types of abnormal postures:

Decerebrate posture -- the arms and legs are out straight and rigid, the toes point downward, and the head arches backward

Decorticate posture -- the body is rigid, the arms out straight, the fists are tight, and the legs are straight out

Opisthotonos -- the back is rigid and arching and the head is thrown backwards

An affected person may alternate between different postures as the condition changes.

Injury or swelling of a part of the brain, spinal cord, or nervous system is the most common cause of abnormal posturing. The type of posturing depends on the type and area of the nervous system involved.

Common Causes

Cerebral edema

Head injury

Increased intracranial pressure due to any cause

Reye syndrome

Stroke

Uncal herniation

Call your health care provider if

People with abnormal posturing almost always have reduced consciousness. Anyone who shows symptoms of abnormal posturing should be examined right away by a health care provider.

In some conditions, such as a coma, these behaviors can continue for a long time.

What to expect at your health care provider's office

All abnormal posturing should be treated in a hospital. This kind of movement is most often seen in patients who are in a coma. More subtle posturing that is caused by a doctor at a medical visit may not be as serious.

At the hospital, emergency treatment for abnormal posturing must be started right away. This includes placing a breathing tube and providing breathing assistance. The person will likely be placed in the hospital intensive care unit.

The medical history will be obtained from family members. A physical examination will be performed.

Medical history questions may include:

When did this behavior start?

Is there a pattern to the occurrences?

Is it always the same type of posture?

What other symptoms came before or occurred during the abnormal posturing?

Is there any history or injury (such as a known head injury)?

The physical examination will include a complete brain and nervous system evaluation.